A 70-Year-Old Woman Visits the Doctor for the First Time

A 70-year-old woman visits the doctor for the first time. She complains of headaches and bad sleep. During the system evaluation, she also notes a sense of inadequate bladder emptying and constipation. The patient has had migraines and persistent sleeplessness in the past. Hypercholesterolemia and osteoarthritis are among her other medical issues. Her migraine meds include amitriptyline, simvastatin, diclofenac, and over-the-counter diphenhydramine for sleeplessness. Which of the following is the most suitable next step in this patient's care?

A) Add topiramate for additional migraine prophylaxis
B) Add zolpidem to treat insomnia
C) Cystography
D) Discontinue diphenhydramine
E) Head CT scan
F) Increase dose of amitriptyline